Double Jaw Surgery and Its Secondary Aesthetic Facial Effects
Q: Dr. Eppley, I had double jaw surgery three years ago to fix sleep apnea. But it caused some unwanted aesthetic changes. I saw a local plastic surgeon and he suggested the following after voicing my facial concerns;
1) Alar Base Reduction. I told him that my nose is wider now and he said it’s a side effect of the double jaw surgery. He said alar base reduction will fix it.
2) Chin Reduction. My chin seems too far forward and a little wide. He didn’t recommend reducing size of chin but he thought sliding it back would suffice. (reverse sliding genioplasty)
3) Lower Facelift. I told him my cheeks are quite saggy. This surgeon said lower facelift fixes saggy cheeks.
4) In addition, is it possible to add on nose tip reduction to all of the above and do together? Double jaw surgery also made my nose tip markedly bigger.
Thanks for your input. Just trying to get my face back to where it was before double jaw surgery.
A:In answer to managing the adverse soft tissue effects of double jaw surgery questions:
1) Nostril widening is very common after a LeFort 1 osteotomy due to the subperiosteal release of all midface muscle attachments to do the procedure. Nostril width reduction by Weir wedges will restore bialar width.
2) Chin reduction by a reverse sliding genioplasty is usually not a good idea. It will cause some increased submental fullness (it pushes back and down the attached submental tissues) and bony notch deformities along the interior border of the jawline. It will also keep the chin wide or make it wider. The more effective approach is a submental chin reduction by bony reshaping which can reduce both horizontal projection and width of the chin with a few far easier recovery.
3) A lower face lift addresses the jowls and neck but will not satisfactorily improve the cheeks. That requires a more direct cheek lift approach. Although I would have to see where you are seeing the cheek sagging.
4) Tip rhinoplasty can be done with any other combination of facial surgeries.
Dr. Barry Eppley